Individual
ERIC J POLCZYNSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
JICARILLA SERVICE UNIT, 12000 STONE LAKE ROAD, DULCE, NM 87528-0187
(505) 759-3291
(505) 759-7288
Mailing address
PO BOX 187, 12000 STONE LAKE ROAD, DULCE, NM 87528-0187
(505) 759-3291
(505) 759-7288
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RP0410102
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000K3526
—
NM
01
—
HSZ196
MEDICARE PART B
NM
Enumeration date
05/08/2006
Last updated
05/27/2008
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